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LOGO
PEMKAB. |
PEMERINTAH KABUPATEN
......................... DINAS KESEHATAN UPTD PUSKESMAS
....................................... Alamat : .......................................................... |
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TINDAK
LANJUT HASIL MONITORING
PEMELIHARAAN
SARANA DAN PRASARANA
PUSKESMAS
................ TAHUN ..............
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No |
Program/
Unit Pelayanan |
Jenis
Sarpras |
Jenis
Kerusakan |
Perbaikan Tanggal |
Pelaksana
Perbaikan |
Kondisi
Pasca Perbaikan |
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.................,
....................2015
Kepala
Puskesmas.......
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NIP.
..........................
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